When One Eponym Suffers Another

The Oxford Handbook of Clinical Medicine is full of charming and hilarious little gems, usually tucked away in the depths of information overload. I would love to meet the authors of this sanity-saving handbook and shake all of their collective hands (while buying them beers).

Today I came across this entry which I felt the need to share:

In 1931, Buerger's* disease caused gangrene in the toes of Harvey Cushing**--the most cantankerous (and greatest) neurosurgeon ever. He had to be wheeled to the operating theatre to carry on his brilliant art (and to continue terrifying his assistants). He had to retire partially, whereupon his colleagues presented him with a magnificent silver cigarette box, containing 2000 cigarettes (to which he was addicted)--one for each brain tumor he had removed during his long career, so verifying the truth that although we owe everything to our teachers, we must eventually kill them to move out from under their shadow.

-Herman Hesse, Demain

And so there is your CME in obscure medical history for the day.  You're welcome. 

--

*Buerger's disease (thromboangitis obliterans) is smoking related inflammation of veins, nerves, and middle-sized arteries (which thrombose, causing gangerene). Cause is unknown. Stopping smoking is vital. Most patients are men. 

**Cushing's disease is bilateral adrenal hyperplasia from an ACTH-secreting pituitary adenoma. He also is known for Cushing's syndrome, and Cushing's triad...but I think we've learned enough for today.

Words of The Day

I had never experienced a "night terror" before traveling to Asia. Well, I thought that was what they were called. I'd wake up in the middle of the night and be: completely paralyzed, seeing someone standing in the door to my room, hearing someone saying my name loudly, or all three.

Then I'd really wake up.

It was extremely frightening, especially since I was mostly traveling alone and staying in, er, less than reputable places. Some of my accommodations were literally mud huts with bamboo doors on them.

Today as I was bumbling through practice USMLE questions I came upon this answer to a question:

So THAT is what they were!!

Hypnopompic and hypnagogic hallucinations.

Ok, so aside from the fact that they are seriously cool words to add to one's vocabulary, I was intrigued by the transient nature of my former "classic symptoms of narcolepsy".

I stopped taking chloroquine about 5 months into my trip and the symptoms stopped. Of course I have heard that 'vivid dreams' are a common side effect of the prophylaxis...but now I can't help but think they should add hypnopompic and hypnagogic hallucinations to the list!
 

Two Cool

2 days ago we had a confirmed (by CT) case of mastoiditis!! This may not seem overly exciting to some folks, but really, it is quite a cool and rare thing to see in North America. Mostly because it is a complication that can arise from an untreated inner ear infection (which almost never happens because ear infections--often viral and self-limiting--are usually overtreated with antibiotics). It was in a patient who had had ear pain for several days following a dive, but had left it until he became unable to sleep due to the discomfort. He presented to the ED with abd pain and dizziness but as he was checking in also mentioned his ear ache.

Vital signs were unremarkable, pt was a fit, middle aged man.

We had a brand new doc on, doing her first locum in an ER so we were all just getting acquainted. When she came out of the room and asked the radiology tech to be called in to conduct a CT of the head we all looked at her like she had two of them. The charge nurse was clarifying,

'For an abd pain?'

'I think he's got a mastoiditis.'

Ohh kaaayyy.

Naturally I went in to take a look, because I am nosey. And I wanted to see why she was suspicious. It is a bit of a zebra diagnosis for an ear ache.

He was exquisitely tender even as I gently pulled his ear up to look in with the scope. I saw a very boggy, swollen, angry looking tympanic membrane with some bloody drainage in the canal. Ohhhh. It looked ugly. And I have seen MANY nasty ears in my time on Baffin Island (hence the colloquial term 'Baffin Ear'). He had only mild post auricular edema and no remarkable adenitis. So we had been a bit skeptical to call in the tech as well as waking up the radiologist who is on call EVERY night and never gets a day off. But sure enough, the CT showed (not the actual CT below but one stellar comparison) the fluid filled area where air ought to be---note the right sided mastoiditis on example below. His looked exactly the same.


So he was admitted, ENT consulted for the morning, started on IV antibiotics and analgesics. We all complimented the doc on her good catch. Many would have sent him packing with an amoxil script. She said the main thing that caused her to suspect the diagnosis was the level of pain that this guy who 'didn't seem like the type to complain' was expressing.

Cool part one.

The second cool thing that happened was I got to give my first cortisone injection! It was a combo of cortisone and marcaine (the marcaine is a longer acting anesthetic--what your dentist uses to 'freeze' your mouth). It was on this guy who was complaining of severe, chronic shoulder pain. He was a very tall bodybuilder and had massive shoulders, covered in tatoos. This made the bony landmarking somewhat of a challenge but apparently I did a bang up job because he said he never even felt the injection. About 15 minutes later he walked out of his cubicle, came up to me and said 'my shoulder has NEVER felt this good, I cannot remember a time when I didn't have pain!'

Ahh, that was just the marcaine talking. But I took the compliment nonetheless. He then asked if I'd do his other shoulder while he was in the department! It was great. I was happy to have the doc talk me through it and glad that the outcome was a positive one (and that I didn't rupture his tendon or something!!!)

All in all, it's been a good week.